Brief Intervention for Drug Misuse for the Emergency Department (BIDMED)

描述（由申请人提供）：尽管筛选、短暂干预和转诊治疗（SBIRT）方法在减少酒精滥用及其相关的冒险行为和负面后果方面是有效的，但很少有研究证明SBIRT对非法和/或处方药滥用的有效性。滥用非法药物和（或）处方药者经常到急诊科求医，特别是由于与滥用药物有关的原因。因此，ED非常适合作为对该人群进行SBIRT有效性分析的场所。急诊科药物滥用简短干预（BIDMED）研究是一项随机对照试验，将包括大型学术创伤中心（罗德岛医院）和社区医院（米里亚姆医院）的成年急诊科患者，他们患有亚危重疾病或损伤，其筛查表明非法和/或处方药滥用。BIDMED参与者将随机接受筛查（SO）或短暂干预（BI），并适当转诊治疗。参与者将使用标准化工具和适应本研究目的的特定工具完成一系列盲法基线评估。所有参与者将在随机分组后的3个月、6个月和12个月进行盲法随访评估。BIDMED研究中提出的主要假设是，与SO组的参与者相比，BI组的参与者将显示出显著更大的减少：(1)随机化后3个月前30天内药物滥用，(2)随机化后6个月与药物滥用相关的行为；(3)随机分组后12个月的负面生理健康、心理健康和社会经济后果。作为次要目标，将评估BI与SO相比对参与者接触、注册和完成药物治疗计划的影响。此外，将测量BI与SO相比对增加艾滋病毒和乙型/丙型肝炎筛查的影响。还将开发和测试一个变化机制模型，该模型解决了预期的变化中介和调节者，以解释在这种情况下SBIRT的影响。此外，将在随机抽样的ED患者中评估非法和/或处方药滥用的流行病学。

DESCRIPTION (provided by applicant): Although screening, brief intervention, and referral to treatment (SBIRT) approaches are effective in reducing alcohol misuse and its associated risk-taking behaviors and negative consequences, there is little research demonstrating the effectiveness of SBIRT for illicit and/or prescription drug misuse. Misusers of illicit and/or prescription drugs frequently seek medical care in emergency departments (EDs), particularly for reasons related to their misuse. As a result, the ED is well suited as a site to conduct an analysis of the effectiveness of SBIRT for this population. The Brief Intervention for Drug Misuse for the Emergency Department (BIDMED) study is a randomized, controlled, trial that will include adult ED patients at a large, academic, trauma center (Rhode Island Hospital) and a community hospital (The Miriam Hospital) who have a subcritical illness or injury and whose screening indicates illicit and/or prescription drug misuse. BIDMED participants will be randomized to receive screening only (SO) or brief intervention (BI) with appropriate referral to treatment. Participants will complete a battery of blinded baseline assessments using standardized instruments as well as adapted instruments specific to the aims of this study. All participants will undergo blinded follow-up assessments at three, six, and twelve months post-randomization. The primary hypotheses addressed in the BIDMED study are that, compared to participants in the SO arm, participants in the BI arm will show a significantly greater reduction in: (1) drug misuse within the prior 30 days at three months post-randomization, (2) behaviors associated with drug misuse at six months post-randomization; and (3) negative physical health, psychosocial health, and socioeconomic consequences at twelve months post-randomization. As a secondary aim, the impact of BI compared to SO will be assessed on participants contacting, enrolling in, and completing a drug treatment program. In addition, the impact of BI compared to SO on increasing uptake of HIV and hepatitis B/C screening will be measured. A mechanisms of change model that addresses the expected mediators and moderators of change to explain the effects of SBIRT in this setting will also be developed and tested. Further, the epidemiology of illicit and/or prescription drug misuse will be assessed in a random sample of ED patients.